Novel method of identifying spinal accessory nerve during modified radical neck dissection in level 2: “SMS Hospital point” and “Upward Pointing Arrow” sign

Neck dissection is now a part and parcel in management of oral malignancies. Like all other surgical procedures, it has a few morbidities, which include iatrogenic trauma to the spinal accessory nerve leading to atrophy of ipsilateral trapezius and sternocleidomastoid muscle. A few identification markers for the nerve have been described in the literature. The markers or structures described previously are not so accurate and give only an approximate idea of where the nerve could be. We have discovered a simple and easily reproducible marker and a sign which helps us identify the nerve each and every time without fail. The junction of posterior belly of digastric nerve, internal jugular vein, and spinal accessory nerve is the point where the proximal end of the nerve is found, and the structures together form an “upward pointing arrow” which helps identify the nerve precisely during neck dissection.